Luyten, Patrick;
Fonagy, Peter;
Campbell, Chloe;
(2023)
9.11 Borderline personality disorder.
In: Lynall, Mary-Ellen and Jones, Peter B and Stahl, Stephen M, (eds.)
Cambridge Textbook of Neuroscience for Psychiatrists.
(477 -483).
Cambridge University Press: Cambridge, UK.
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Abstract
This chapter considers the neuroscience of borderline personality disorder, also known as emotionally unstable personality disorder, focusing on three domains: neuroendocrinological, structural and functional findings. Research in these areas is related to clinical understanding of borderline personality disorder as characterised by (a) emotional dysregulation, (b) impulsivity and (c) social dysfunction. In patients with borderline personality disorder, the hypothalamic–pituitary–adrenal (HPA) axis tends to show showing elevated continuous cortisol output and blunted cortisol following psychosocial challenges. The amygdala and hippocampus differ from healthy controls in terms of both reduced volume and measurable activity, and the dorsolateral prefrontal cortex tends to be less active. The neurobiology of borderline personality disorder can be characterised as a proneness to flooding by cortisol, with the amygdala working to heighten the affective meaning of stressful stimuli, and the prefrontal cortex underperforming in the task of downregulating emotional experience. The chapter also considers genetic findings in relation to borderline personality disorder.
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